This paper discusses the question of ‘good governance’ in relation to the current debates about global development and health. It explores the challenge of health governance in the face of interconnected complex developmental transitions. The discussion takes on this multiplicity of transitions and looks at ways to re-think global health within a new development consensus that integrates public goods and rights-based approaches. A rights-based approach and a substantive focus on ‘publicness’ help to lock down the ‘wicked problem’ of health governance and provide the basis for coherent, shared understanding when approaching the hard questions of good governance, given the realities of mixed health systems and complex transitions. Coordination and consensus can be built around three main development goals: substantive health rights, democratic procedures and the protection and formation of public goods.